Description

Total Knee Replacement is one of the most frequently done and successful treatment for severe knee arthritis. Knee arthritis is mostly degenerative which happens as age advances. This is called osteoarthritis. Other common type of arthritis is rheumatoid arthritis. With advancing arthritis patient finds difficulty in walking, climbing stairs or sitting on floor. For early knee arthritis conservative treatment like pain killers, exercises and walking aids are helpful. With increasing arthritis one may find it quite difficult to pursue his routine day to day activities and nonsurgical treatment may fail to relieve pain. Total knee replacement is safe and successful procedure for advanced arthritis. Today more than 200,000 knee replacements are being done in India every year. Improvement in technology and instrumentation and understanding of knee biomechanics has improved the outcome of knee surgery drastically. Today average longevity of knee prosthesis is more than 15 years. Causes of damage of the knee: Two most common causes are osteoarthritis and rheumatoid arthritis. Osteoarthritis mostly occurs with advancing age (above 60 years) whereas rheumatoid arthritis may affect younger individuals. Management: Knee joint is formed between thigh bone (femur), leg bone (tibia) and knee cap (patella). When we walk glistening surfaces of leg, thigh bones and knee cap, which are covered by articular cartilage, move on each other. Arthritis is actually the damage of this articular cartilage. With damage of articular cartilage joint space reduces and new bone spurs (osteophytes) form around knee joint. Diagnosis: Diagnosis is obvious when an old age patient gives typical clinical history of pain in walking and climbing stairs. On examination joint line tenderness is classically present. Crepitus may be felt (sound heard and felt with knee movements) in advanced arthritis. X ray of an arthritic knee is always taken in standing position to assess the joint space. This space is typically reduced in arthritis. Who needs Total knee replacement? Decision of knee replacement should actually a mutual agreement between patient and surgeon. If knee pain troubles you in doing day to day routine activities like walking, using stairs etc, and your standing X ray shows loss of joint space you are right candidate for this surgery. Patient Preparation Day before surgery you are admitted to hospital for some blood and urine investigations, ECG, ECHO and chest X ray. Total knee replacement is done under combined spinal-epidural anaesthesia for which you have to be fasting for 8 hours before surgery. Hairs from the operating side are removed in the operation theatre before surgery. If you are on blood thinner drugs (Aspirin, clopidogrel), these drugs are stopped three to five days before surgery. Patient on anti-rheumatoid drug should continue these drugs. Some patient of rheumatoid arthritis might be on oral steroids which needs to be substituted by injectable dose of steroid on the day of surgery. Indications- 1. Damaged knee with advanced arthritis (osteoarthritis or rheumatoid) 2. Osteonecrosis (death of bone cells ) collapse of femoral condyle 3. Post fracture secondary arthritis 4. Gouty arthritis

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